Located across Plantation Street from the hospital and medical school at One Biotech Park, the room has 8˝-by-11 inch charts that track the progress on pieces of the sprawling health system: revenue, expenses, total employees, patient volume, patient satisfaction, readmission rates, and many more.

Dr. Dickson, the former emergency medicine doctor who took over the helm of UMass Memorial in March 2013, even has a chart that tracks the system's ability to implement ideas from its front-line employees. He has tied compensation for all his managers to their ability to implement these good ideas, which are meant to improve the patient experience, save money, or both.

Dollars and cents are on the front burner as the nonprofit grapples with operating losses of $55 million in fiscal year 2013. Had it not been for the one-time sale of its laboratory service and home health care divisions, along with robust income from investments, UMass Memorial would have ended the year in deficit.

UMass Memorial Health Care is seeking to cut between $50 million and $115 million from its $2.3 billion operating budget before the end of the fiscal year on Sept. 30.

"We are looking at everything across the board," said Dr. Dickson. "We need to look at all of the overhead in the system, and we need to sell or eliminate waste in the system. Our dollars have to be spent on our mission, not on overhead."

To that end, UMass Memorial has laid off more than 300 employees since Oct. 1; has put the medical office building at 11 Shattuck St. up for sale; has agreed to transfer ownership of the 74-bed Wing Memorial Hospital in Palmer to Baystate Health in Springfield; has shuttered the Caitlin Raymond Bone Marrow Registry; and is considering a number of other moves to reduce its size.

Dr. Dickson's plan to streamline UMass Memorial and cut waste is modeled on lean manufacturing principles founded in Japan by Toyota. And he is hoping employees help him push UMass Memorial to be leaner.

He has a blog, "Everyday Innovators," where he discusses employees' ideas and how to make them happen. He holds regular meetings with some of the 13,000 employees to discuss their ideas, and visits departments that have made changes.

In one blog item, he discussed ideas from employees about how to cut down on patient wait times, to ensure that every patient can get an appointment that day, or the next day.

In another, he discussed his visit to Plumley Village Health Services, a UMass Memorial clinic; and about supporting employees who have been laid off with résumé writing and job interview skills.

UMass Memorial is on the hunt for good ideas, from the chief executive officer on down.

This is not the first time UMass Memorial has undergone a major shakeup after operating losses.

In 2001, the hospital group lost $24 million, which followed an operating loss of $9 million in 2000. UMass Memorial laid off 300 employees and did not fill 200 other jobs that had been left vacant. It hired a consultant to review the hospital's finances and brought in a new CEO.

Although the nonprofit has facilities in Clinton, Leominster, Fitchburg, Marlboro and Palmer, UMass Memorial officials said the majority of the most recent operating losses stem from four Worcester campuses: University (Lake Avenue), Memorial (Belmont Street), Hahnemann (Lincoln Street), and the former City Hospital property on Queen Street.

"Layoffs are just the worst thing you can do," said Dr. Dickson, who began his career at UMass Memorial as a respiratory therapist. "I've laid off friends, colleagues whom I worked with for 20 years. It has been unbelievably difficult."

The nonprofit has also hired 80 new nurses, at a cost of approximately $15 million annually, in order to settle a contract with two nursing unions that had threatened to go on strike.

Dr. Dickson said several times during an interview that "everything is on the table" for consideration.

"Overall, our footprint is bigger than what we need for the patients we serve," Dr. Dickson said. "We need to shrink the size of our organization, or else it will eat into our long-term efforts."

Since Oct. 1, 2013, the layoffs have happened mostly in management and non-medical positions. The nonprofit laid off 303 managers and other employees in December and January — "vice presidents, directors, managers and staff, including a small number of clinical staff," according to a UMass Memorial press release at the time. About a third of those layoffs occurred in vacant positions. The cuts came in departments like human resources, information technology and financial services, as well as secretarial staff and other employees in the hospital's physician group. Of those laid off, 194 employees belonged to a union, a UMass Memorial spokesman said.

More recently, UMass Memorial began laying off employees who have direct contact with patients, shifting those responsibilities to nurses and nurses' aides.

Dr. Dickson and Patrick L. Muldoon, president of UMass Memorial Medical Center, characterized these moves as "bringing care directly to the bedside."

"Throughout all of these moves, patient safety and the quality of patient care are first and foremost, and will remain so," Mr. Muldoon said. "Even as we make these difficult decisions, patient safety is our number one purpose. It must remain front and center."

UMass Memorial has discussed layoffs with 23 phlebotomists and two personal care assistants, but as of Friday, no decision had been made, and no layoff notices had been issued to those employees, according to UMass Memorial spokesman Robert Brogna.

Already the system has laid off two respiratory therapists and 63 patient safety associates, who work directly with patients.

Phlebotomists are specialists who draw blood from patients for testing. Respiratory therapists work with patients on inhalers, among other tasks related to pulmonary health; patient safety associates watch patients who have mental or medical issues that might cause them to wander from their beds.

Janet Wilder, an organizer with the State Healthcare and Research Employees, a union that is part of the American Federation of State, County and Municipal Employees, said SHARE represents about 2,700 employees at UMass Memorial. About 100 SHARE union members have been laid off in recent months, she said, although about a third of those employees have found other jobs within the system.

"Being laid off is a hugely emotional experience," she said. Although there are some retraining programs and retraining funds available through SHARE, the retraining is happening only for small numbers of laid off employees, she said.

"We would like the changes to happen with enough forethought to retrain them for other jobs within UMass," she said.

The medical office building at 11 Shattuck St., recently put up for sale, currently houses about 50 employees, including those who create credentials for medical staff, as well as quality and patient safety employees. Those employees will be moved to other UMass Memorial-owned buildings if and when the building is sold, according to Dr. Dickson.

David Schildmeier, spokesman for the Massachusetts Nurses Association, said UMass Memorial officials had promised not to cut support staff when the nonprofit hired the 80 new nurses stipulated in its contract. He said the cuts of patient safety advocates, and phlebotomists (if laid off), represents a breaking of that promise.

"There is no way to implement these cuts without affecting the quality of patient care," he said. "You are going to have nurses working faster, doing more, and that will undermine the quality of care. The decisions they are making are having a negative impact on the quality of care that UMass provides."

Colleen Wolfe, a Memorial campus nurse and co-chair of the negotiating team for the union, said that some of the changes UMass Memorial has made will have a negative impact on patient safety.

"Taking away ancillary staff takes us away from the bedside," she said. "The answer to the hospital's financial woes should not be to add responsibilities to the nurses."

Margaret McLaughlin, a University campus nurse and co-chair of the union negotiating team, said the layoffs of phlebotomists, patient safety associates and respiratory therapists shows a "total disregard for bedside nursing, and a total disregard for the patients."

"Laying off the PSAs (patient safety associates) has put the safety of some patients at high risk," she said. "The nurses have to watch them, what if they wander? It could be unsafe for other patients in the hospital as well."

As for phlebotomists, Ms. McLaughlin said the very specialized work they do cannot be replicated as well by nurses.

"Nurses do a lot of things very well, but if you are asking them to draw more blood, it will mean more (needle) sticks to get the same amount of blood," she said. "That is clearly not a good thing for patients, many of whom are the sickest we serve."

Ms. Wilder, the SHARE organizer, said that there are some changes UMass Memorial has made for the better, and that Dr. Dickson and the management team are sincere in their efforts to tap frontline workers for their ideas.

Instead, the department proposed its own inner reworking, implementing cost saving ideas that did not lead to layoffs. The department has saved about $750,000 so far, she said, with more expected.

"It's a very difficult time to be working in hospitals," Ms. Wilder said. "The financial pressures are huge. Everyone is worried about their jobs. I think these changes require the full participation of all employees."

Aaron Nicodemus can be reached at aaron.nicodemus@telegram.com. Follow him on Twitter at @anic89